POS1258 LESS THAN EXPECTED IMPACT OF RHEUMATOID ARTHRITIS AND AXIAL SPONDYLOARTHRITIS DISEASE ON COVID SEVERITY
Authors: S. Keeling, B. Pan, E. Hutchings, S. Wichuk, M. Osman, A. Singh, A. Sonpar, I. Swartz, W. P. Maksymowych
Journal: Annals of the Rheumatic Diseases (2022)

Background Throughout the pandemic, there has been ongoing concern that people with autoimmune diseases such as rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) will have more severe COVID-19 disease due to immune dysfunction associated with autoimmune diseases and their treatment. Objectives We aimed to compare the severity of COVID-19 in patients with RA versus axSpA and characterize the predictors of COVID-19 severity during the pre-Omicron pandemic phases. Methods The IMPACT (I MP act of inflammatory A rthritis on C OVID Outcomes S T udy) study is a monthly survey of two established northern Alberta, Canada prospective cohorts of RA and axSpA patients from November 2020-2021 who answered Redcap surveys through de-identified email link surveying patient demographics, disease characteristics, COVID-19 symptoms, treatment of RA and axSpA, health care utilization, vaccination status and vaccine adverse events. Descriptive and univariate analyses (dependent variable = severe COVID-19) were performed followed by multivariate analyses of all significant and clinically relevant independent variables from the univariate analysis. Infection severity was defined as any patient with COVID-19 symptoms who visited a doctor, ER or required hospital admission. Results 773 of 2167 (36%) patients (RA n=574, axSpA n=197) registered in both cohorts answered at least one baseline survey, 28 (4%) reporting positive COVID-19 tests (24 positive once). Of 442 reporting COVID-19 symptoms during the survey, 11 (3%) were admitted for a mean of 4 days, 2 requiring ICU or blood clot treatment and 1 requiring advanced therapy. 116 (26%) visited a physician for Covid symptoms. Univariate analysis showed that the use of steroids, NSAIDs and increased disease activity were associated with having less severe infection but these associations were not significant in the multivariate analysis (Table 1). There were no significant impacts of RA vs axSpA, age, gender, treatment, disease activity, or smoking. Table 1. Multivariate Level Mixed-Effect Logistic Regression Model: IMPACT of RA and axSpA Disease Characteristics on COVID Infection Severity Defined as Patients with COVID Symptoms Requiring Visit to Doctor, Emergency Room and/or Hospital Admission. Variable Coefficient (S.E ) Odds Ratio (95 % Confidence Interval ) P-value Gender Male 0.17 (0.34) 1.18 (0.61 – 2.31) 0.6193 Female Reference Age -0.01 (0.01) 0.99 (0.97 – 1.01) 0.2543 Rheumatic Disease Type RA 0.18 (0.40) 1.20 (0.58 – 2.48) 0.6213 SpA Reference Steroids Yes -0.40 (0.56) 0.67 (0.23 – 2.01) 0.4757 No Reference NSAIDS Yes -0.20 (0.26) 0.82 (0.49 – 1.37) 0.4508 No Reference Current Disease Activity -0.04 (0.06) 0.96 (0.85 – 1.09) 0.5275 HAQ -0.03 (0.29) 0.97 (0.55 – 1.70) 0.9041 Nicotine products Yes -0.67 (0.37) 0.51 (0.25 – 1.06) 0.0714 No Reference Cannabis products Yes -0.45 (0.31) 0.64 (0.35 – 1.18) 0.1510 No Reference DMARDs Yes 0.26 (0.30) 1.30 (0.72 – 2.35) 0.3860 No Reference Biologic DMARD Yes -0.46 (0.43) 0.63 (0.27 – 1.46) 0.2813 No Reference Conclusion Possible disease related risk factors for increased COVID-19 severity in RA and axSpA patients preceding the onset of the Omicron variant including use of steroids or DMARDs were not associated with severe infection. These findings are consistent with other international studies whereby other non-rheumatic disease comorbidities played a greater role in infection severity. Acknowledgements Epidemiology Coordinating and Research (EPICORE) Centre provided support for the REDCAP survey and biostatistical anayses. Disclosure of Interests Stephanie Keeling Speakers bureau: Abbvie, GSK, Pfizer, UCB, Consultant of: Abbvie, GSK, Pfizer, Sandoz, UCB, Eli-Lilly, Galapagos, Novartis, Grant/research support from: Abbvie, UCB, Sandoz, Pfizer, Merck, Bo Pan: None declared, Edna Hutchings Shareholder of: BMS, Stephanie Wichuk: None declared, Mohammed Osman Speakers bureau: Boehringer Ingelheim, Takeda Pharmaceuticals, Grant/research support from: Yes, Boehringer Ingelheim and CSL-Behring, Ameeta Singh: None declared, Ashlesha Sonpar Speakers bureau: Novartis, Ilan Swartz: None declared, Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB , Consultant of: Abbvie, Boehringer Ingelheim, Celegene, Eli-Lilly, Galapagos, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, UCB